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Friday, April 22, 2016

It is becoming clearer by the day that our newly elected federal government has an insatiable appetite for talking progressive while governing conservative. I suspect this will be our new normal until election time. The behaviour pattern is obvious. I doubt Mr Trudeau's feel-good activism on that frontier will carry the Liberals much longer. Canadians are catching on to them.Anyhow, as a quick reminder, the Canadian Supreme Court declared that parts of the Criminal Code that criminalize assisted dying are unconstitutional.Canada's Liberal government introduced its legislation on assisted dying in parliament. It is being debated in committee today.Here's the legislative draft proposal

A person has a grievous and irremediable medical condition if

(a) they have a serious and incurable illness, disease or disability;

(b) they are in an advanced state of irreversible decline in capability;

(c) that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and

(d) their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

Compare that to the Supreme Court's criteria:'‘competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.'Ii is trivially true that 'd' in the legislative draft is too restrictive, given the criteria the Court has set. Terminal illness is not a defensible threshold condition for access. Patients do not have to be in an advanced state of irreversible decline in capability either. Excluding not terminally ill patients from access who meet the above mentioned Supreme Court criteria would clearly violate Canadians' Charter rights. Government released today its rationale for the proposed policy. Here we go,Restricting access to only those individuals whose death is reasonably foreseeable allows them to choose a peaceful, medically assisted death where their medical circumstances are such that the dying process would otherwise be painful, distressing, frightening, prolonged or otherwise lacking dignity from their perspective. This approach respects autonomy during the passage to death, while otherwise prioritizing respect for human life and the equality of all people regardless of illness, disability or age. It also furthers the objective of suicide prevention and the protection of the vulnerable. Recognizing the complexity of the legal and social issues associated with medical assistance in dying, this approach strikes an appropriate balance between the competing rights, interests and values.

It's plain for everyone to see that the Rationale is not actually a rationale as it does not explain at all why terminal illness is introduced as an eligibility threshold. The Justice department's briefing acknowledges the problem, it states,This could impact the section 7 Charter rights of those who are suffering intolerably as a result of a serious and incurable condition, but whose natural death is not reasonably foreseeable. This could include individuals suffering only from a mental illness, and individuals with physical disabilities who lack the physical capacity to end their own lives. Persons with mental illness or disabilities would only have access to medical assistance in dying if they meet all of the eligibility criteria.And yet, our government (lacking a rationale to actually respond to this concern), pushes ahead anyway. I trust you will savour the Catholic language introduced in the rationale, where government prioritizes 'respect for human life' over our Charter right to make decisions about our continuing existence based on competent, autonomous choice and our actual quality of life. Intractable human suffering is apparently of no concern to the Liberals. Go figure. Truly, this is legislation the Harper Conservatives could have drafted.

Tuesday, April 19, 2016

Stefan Eriksson at Uppsala University and his colleague Gert Helgesson at the Karolinska Institute have undertaken the commendable job of creating two lists of English language bioethics journals, one featuring journals published by reputable publishers and another one featuring journals associated with other publishing outfits. Each of their critical choices is accompanied by links providing evidence in support of their concerns about the journals/publishers in question. It is doubtful that some of the questionable journals actually qualify as journals in any meaningful way. There is one such journal, for instance, that published a full one article in its three years of existence. The wonders of fee-for-upload open access publishing...

The list created by Ericsson and Helgesson should prove to be tremendously useful as a guide for junior faculty who wonder where to submit their first academic outputs for peer review, but it's also helpful to those of us who have been around for longer and are asked to provide sound publishing advice that goes beyond guessing the quality of particular journals.

Not unexpectedly, the list isn't quite complete, even as far as English language journals are concerned (e.g. the superb Indian Journal of Medical Ethics is missing in action), but it's a great start, and undoubtedly future iterations of the list will move closer to comprehensiveness. The list also does not aim to include journals other than English language journals. It's probably a fair enough approach as it would be a mammoth task indeed to check whether particular journal titles in other languages fall into one or the other category of publications.

Thursday, April 14, 2016

Canada's Liberal government introduced its legislation on assisted dying in parliament. There's a lot to talk about there, but let me focus on the government's most brazen ignoring of the eligibility criteria the Court has established.Here's the legislative draft proposal

A person has a grievous and irremediable medical condition if

(a) they have a serious and incurable illness, disease or disability;

(b) they are in an advanced state of irreversible decline in capability;

(c) that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and

(d) their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

Compare that to the Supreme Court's criteria:

'‘competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.'

I'm sure even lay persons appreciate that 'd' in the legislative draft is simply too restrictive, given the criteria the Court has set. Terminal illness is not a defensible threshold condition for access. Patients do not have to be in an advanced state of irreversible decline in capability either. Excluding not terminally ill patients from access who meet the above mentioned Supreme Court criteria would clearly violate Canadians' Charter rights. Apparently that is of no concern to our government.

To cut a long story short, if this becomes law, a Charter challenge will occur sooner rather than later, and the matter will be fixed in the Court. It is shocking that a Liberal government would continue the Harper government's tradition of trying to subvert Supreme Court decisions.

Friday, April 01, 2016

I will be on the road a bit during the next few weeks, giving various talks in various places. In case you happen to be around, say 'hi' :).

I will be in Charleston, SC between April 6-8 to give a talk on the Ethics of Catastrophically Ill Patients Access to Unregistered Medical Interventions as part of the Thomas Pitts Memorial Lectureship in Medical Ethics at the Medical University of South Carolina.

From April 11-13 I will be at Williams College, MA to give a talk on the Ethics of Catastrophically Ill Patients Access to Unregistered Medical Interventions in the context of the Ebola virus outbreak in West Africa in 2014/15. I will also run a seminar on intractable depression and assisted dying there.

From May 9-11 I will be at Erasmus University in the Netherlands, giving talks on the Ethics of Catastrophically Ill Patients Access to Unregistered Medical Interventions and on why I think there should be no conscientious objection accommodation for doctors in liberal democracies.

From May 12-14 I will be attending the Euthanasia 2016 congress in the Netherlands, offering a presentation on the current state of play in Canada (on a panel with Margaret Battin), as well as a presentation on intractable depression and assisted dying.

So, if you happen to be in the vicinity and you always meant to say 'hi', don' hesitate.